Cost Proposal

Request for Proposals

Minnesota Department of Health

Emerging Professions Toolkit to Advance the Minnesota Accountable Health Model

Instructions: Complete the Cost Proposal by filling out the twoforms listed (and attached):

  • Form B1: Emerging Professions Toolkit Contractor’s Budget Template
  • Form B2: Budget Justification Narrative

A sample of both of these forms is available on the following pages.

Form B1: Emerging Professions Toolkit Contractor’s Budget Template

Applicant/Toolkit Contractor:
Total Contract Period: March 1, 2015 –February 28, 2016
Budget Form Instructions for Toolkit Contract Applicants:
1. Complete a separate budget for each grant year - Year 1 (2015) and Year 2 (2016) (see tabs).
2. Include costs for the grant recipient in Salaries & Wages, Fringe, Supplies, Travel, and
Other categories.
3. Include contractor costs (contracts with vendors that will be providing a specific service such as IT or
consultation) in C. Consultant Costs.
4. Enter information in cells highlighted in blue as applicable for your project.
The amount paid for deliverables in section two is based on costs in section one.
Section One
A. SALARIES & WAGES: For each position, provide the following information: position title, hourly rate,
and number of hours allocated to the project.
In Form B2 Budget Justification Narrative, provide a brief position description for each position listed.
Title / Hourly Rate / Hours / Total
$
$
$
$
$
$
Total Salaries and Wages: / 0 / $
B. FRINGE: Provide information on the rate of fringe benefits calculated for the total salaries and wages for positions
in 1A.
Enter the fringe benefit rate as a % of the total salaries and wages in decimal format.
Total Fringe: / $
C. CONSULTANT COSTS: Provide the following information for consultants/contractors: name of contractor or
organization, hourly rate, number of hours, services to be provided.
In Form B1 provide a brief background about the contractor including how previous experience relates to the project. If
the contractor has not been selected, include a description of the availability of contractors for the services or product,
a description of the availability of contractors for the services or product, and the method that will be used for
choosing a contractor.
Hourly Rate / Hours / Total
Hourly rate and number of hours / $
Name:
Organization:
Services:
Total Consultant Costs: / $
D. EQUIPMENT: Equipment costs are not allowed.
Item / Unit / Cost/Unit / Total Cost
Total Equipment Costs: / $
E. SUPPLIES: List each item requested, the number needed, and cost per unit. Include expected costs for general
operating expenses such as office supplies, postage, photocopying, and printing.
Item / Unit / Cost/Unit / Total Cost
$
$
$
$
Total Supply Costs: / $
F. TRAVEL: Provide estimated travel costs below for in-state travel. Include travel costs for hotels, meals, and attending meetings. Include the estimated number of miles planned for project activities and
the rate of reimbursement per mile.
Out of state travel is not an eligible expense. Travel costs are not to exceed rates established in the Commissioner's Plan at
Item / Total Cost
Total Travel Costs: / $
G. OTHER: If applicable, list items not included in previous budget categories below.
Include a detailed description of the proposed expenditures in Form B2 Budget Justification Narrative.
Item / Total
Total Other Costs: / $
GRAND PROJECT TOTAL / $
Section Two
DELIVERABLES: The amount paid for deliverables in section two is based upon the total dollars requested in
section one. Budget deliverables are to cross reference the deliverables in the Task section of the RFP.
Deliverable: / Avg by Hour / Estimated Hrs / Billable Amt
$
$
TOTAL / $
Deliverable / Avg by Hour / Estimated Hrs / Billable Amt
$
$
TOTAL / $
Deliverable: / Avg by Hour / Estimated Hrs / Billable Amt
$
$
TOTAL / $
Deliverable: / Avg by Hour / Estimated Hrs / Billable Amt
$
$
TOTAL / $
GRAND PROJECT TOTAL / $

Form B2: Budget Justification Narrative

The Budget Narrative provides additional information to justify costs in Form B1 Budget.

Instructions: Provide a narrative justification where requested. The narrative justification must include a description of the funds requested and how their use will support the proposal.

  1. Salaries and Wages
This should include all personnel whose work is tied to the proposal.
Narrative Justification(enter a brief description of the roles, responsibilities, and unique qualifications of each position):
  1. Fringe

Narrative Justification(provide information on the rate of fringe benefits calculated for salaries and wages):
  1. Consultant Costs

Narrative Justification(provide a brief background about the contractor including how previous experience relates to the project. If the contractor has not been selected, include a description of the availability of contractors for the services or product and the method that will be used for choosing a contractor):
  1. Equipment Costs

NOTE: Equipment costs are not allowed.
E. Supplies
Describe costs related to each type of supply, either in Budget Form B1 or below.
Narrative Justification (enter a description of the supplies requested and how their purchase will support the purpose and goals of this proposal):
F. Travel
Travel may include costs associated with travel for meetings and other items included in the deliverables.
Narrative Justification (describe the purpose and need of travel and how costs were determined for each line item in the budget):
G. Other
Narrative Justification (explain the need for each item and how their use will support the purpose and goals of this proposal. Break down costs into cost/unit: i.e. cost/meeting and explain the use of each item requested):